Journal of Clinical Oncology, Vol 15, 2329-2337, Copyright © 1997 by American Society of Clinical Oncology
Race and clinical outcome in breast cancer in a series with long-term follow-up evaluation
R Heimann, D Ferguson, C Powers, D Suri, RR Weichselbaum and S Hellman
Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago, IL 60637, USA. heimann@rover.uchicago.edu
PURPOSE: To compare the outcome of African American (AA) and Caucasian (C)
breast cancer patients who had equivalent disease extent and were similarly
treated. PATIENTS AND METHODS: We compared prognostic characteristics,
treatment, and outcome of 1,037 C and 481 AA breast cancer patients treated
with mastectomy between 1946 and 1987. The median follow-up duration was
15.6 years. RESULTS: During the study period, there was a successive
increase in the percent of patients who presented with early breast cancer.
Between 1980 and 1987, 35.1% AA versus 47.6% C patients had < or = 2-cm
tumors and 50.0% AA versus 61.9% C patients were node-negative, while
between 1946 and 1959, 27.7% AA and 31.3% C had < or = 2-cm tumors and
41.5% AA versus 40.4% C patients were node-negative. The treatments were
similar during the study period. The 20-year disease-free survival (DFS)
rate of AA compared with C patients with node-negative < or = 2-cm, 2.1-
to 4-cm, and greater than 4-cm tumors and of patients with one to three and
> or = four positive nodes was not significantly different. Equal-size
tumors had similar proportion of positive axillary nodes in AA compared
with C patients. The DFS for AA patients compared with C patients was
similar in the periods 1946 to 1959, 1960 to 1969, and 1970 to 1979, but
was lower between 1980 and 1987 (P = .02). In multivariable analysis, race
was not a significant variable. CONCLUSION: In this large group of
uniformly treated breast cancer patients, race was not an independent
factor that influenced outcome. The racial differences seen between 1980
and 1987 are likely because of a larger percent of greater than 2-cm and
node-positive tumors in AA patients. Education and access to early
diagnosis should reduce or eliminate the racial differences seen.
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